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Patient Care Services 300 Pasteur Drive Stanford, CA 94305 Helpful Tips For Managing Nutrition Side Effects Patient Education You may require a nutritional supplement drink to help meet your calorie and protein needs during treatment. Your medical team and registered dietitian can help you decide which drink is appropriate. Get Full Too Fast? Try these tips to increase calorie intake and make every bite count. Add butter or margarine to soups, hot cereal, mashed potatoes, rice, or bread. Add an extra serving of olive or canola oil or mayonnaise to salads, eggs, casseroles, or sandwiches. Try a nut or seed butter such as peanut butter, almond butter, or sunflower seed butter on bananas, crackers, bread, or on sandwiches with cream cheese, jelly, chocolate-hazelnut spread, or honey. Add honey to tea, coffee (hot or cold), fruit, or bread with butter or nut butter. Try sour cream or cream cheese on cooked vegetables, potatoes, beans, carrots, squash; dollop on soup or use as part of a dressing for fruit, or a dip for vegetables. Try whipped cream or heavy cream with pie, fruit, cake, pudding, or hot chocolate. Add avocado to sandwiches or pair with tuna, egg, or chicken salad. Too Tired To Eat? Take advantage of the times when you’re feeling well by preparing meals in large batches so you can freeze them for difficult days. Eat even if it isn’t mealtime, and choose foods of increased nutritional value. Try eating smaller portions of easily digested foods and slowly work back to normal. Make dishes that do not require a lot of clean-up; use foil containers, frozen dinners, paper, and plastic. Use canned creamed soups for nutritious, good-tasting sauces. Combine with chicken or fish and serve on instant brown or white rice or noodles. Not Hungry? Rely on food that your really love during periods when your appetite is poor. Concentrate on making your meal more enjoyable; let someone else do the cooking. Accept gifts of food and offers to help prepare meals. Try ice cream mixed with ginger ale or your favorite carbonated beverage as a drink. Try eggnog, milkshakes, frappes or frozen yogurt. Eat small quantities of food every 2 to 4 hours. Mouth Soreness/Difficulty Chewing and Swallowing? The lining of the mouth and throat are among the most sensitive areas of the body. Soreness or difficulty chewing and swallowing due to your treatment may occur. Remember, however, that part of the healing process in this area of the body depends upon your eating well and drinking fluids. If your mouth is dry, ask your physician whether medicines you are taking are causing the dryness. If your gums, tongue and throat become dry or sore, be sure to follow the mouth-cleaning regimen. Some Do’s and Don’ts If Your Mouth is Sore- Do: Avoid too cold or too hot foods and beverages. Try tilting your head back or moving it forward to make swallowing easier. Use a straw or drink your food from a cup instead of using a fork or spoon. Rinse your mouth whenever you feel you need to remove debris, stimulate your gums, lubricate your mouth or refresh taste in your mouth. Try rinsing every two hours while you are awake, especially before and after eating. Have your doctor prescribe artificial saliva for severe dryness; also try sugarless candy, mints or sour balls to stimulate saliva. Caffeine from tea or coffee may worsen dry mouth. Soften or moisten food by dipping them in liquid or taking a sip of a beverage with food. Choose soft foods such as mashed potatoes, cottage cheese, scrambled or poached (not runny) eggs, custards, egg salad, ricotta cheese, puddings, creamy soups and cereals, cheese and rice casseroles, macaroni and cheese, and meatloaf. Eat soft fruit like bananas, canned pears or peaches, and applesauce. Try blending hard-to-chew meats with gravies or creamed soup. Eat ice cream, sherbet, or make popsicles with milk or milk substitutes. If Your Mouth is SORE- Don’t: Use spices. Smoke; it can irritate your mouth and throat. Lick your lips; this increases dryness and chapping. Drink citrus, acidic, or alcoholic beverages; they can be irritating and may burn or sting. Eat hard, dry or fried foods, raw vegetables and foods with seeds and tough skins. What To Do About... Getting Enough Protein Here are some suggestions on how to improve your protein intake without increasing the amount of food you eat. Use skim milk powder or protein powder to add protein to foods. Drink fortified milk or use it in recipes (1 cup low fat powdered milk to 1 qt. regular milk). Add skim milk powder to hot cereals, soups, scrambled eggs, gravies, ground meats (for meatballs, meat patties, meat loaf) and casserole dishes. Try yogurt alone, in soups or as a dip. Use whole or fortified milk or half-and-half instead of water when making soups, cereal, pudding, and instant cocoa. Add ground meat to soups or casseroles. Add grated or chunks of cheese to sauces, vegetables, soups, or casseroles. Add cream cheese spread or peanut butter to bread, sauces, waffles, or crackers. Add cooked or cubed tuna, salmon, shrimp, chicken, diced ham, or sliced boiled eggs to sauces, rice, noodles, buttered toast, or hot biscuits. Choose dessert recipes that contain eggs, such as sponge cake, custard or rice puddings. Try meat substitutes, such as tofu, peas, beans, or soy milk. Dehydration There may be times when you do not feel like eating at all. This will put you at risk for becoming dehydrated. Signs of dehydration can include dark colored urine, decreased appetite, weakness, weight loss, confusion, and poor skin appearance. It is important that you drink fluids throughout the day. A healthy person at rest and not perspiring needs approximately1800 cc to 2500 cc (8 to 10) 8 oz cups daily. Fluids such as fruit juices, nectars, Gatorade, and broths which supply calories as well as some vitamins, minerals and electrolytes are strongly encouraged (water contains none of these). Keep liquids by your bedside and sip them frequently throughout the day. Lactose Intolerance Lactose (milk sugar) is found in all milk products. Individuals with lactose intolerance do not have enough lactase enzyme in their intestines to digest milk products. Lactose-containing foods may cause problems such as abdominal cramping, bloating or diarrhea for these individuals. Lactose intolerance is very individual and may be temporary. Milk products may be tolerated at a later date, but be sure to add them back gradually. Foods that contain lactose should be monitored closely when you have an intolerance. Lactose content varies in each item. Milk has much more lactose than cheese or ice cream, so cheese and ice cream may be better tolerated than milk. Lactose containing products include all milk and milk products such as ice cream, cheese, puddings, creamed soups, chowders, and all commercially prepared soups that contain milk or milk products. A product in the supermarket called Lactaid Milk contains digested lactose. You may find this product easier to tolerate. In addition, lactase enzyme pills or drops which break down lactose for easier digestion are available in most drugstores. These should be taken with meals that contain milk products. Read the label carefully before using. Abdominal Cramping Avoid foods that encourage gas or cramps, such as carbonated drinks, beer, beans, onions, cabbage, broccoli, cauliflower, spicy or greasy foods, too many sweets, and chewing gum. Avoid rich or fatty foods and eat smaller amounts of food more often. Do not skip meals. Try to chew with your mouth closed. Talking while you are chewing may cause you to swallow excess air causing more gas. Limit large volumes of cold beverages and ice in beverages. Try warm food instead of hot foods since hot foods can increase the natural movement of the intestinal tract. Use a straw with beverages. Alternative Nutrition Choices... It is important to eat a well balanced diet during cancer treatment to help maintain your strength and immune system. Restricting or altering your diet during chemotherapy puts you at increased risk for malnutrition and weight loss. Your registered dietitian can help provide education about eating during cancer treatment. This document is intended for use by staff of Stanford Hospital and Clinics. No representations or warranties are made for outside use. Not for reproduction or publication without permission. Direct inquiries to Stanford Hospital and Clinics. Cancer Center/Nutrition 5/2011.